Critical Illness and End-of-Life Issues: A Global View

In the United States, we have had considerable difficulty tackling end-of-life issues in the intensive care unit (ICU). With medicine and pharmacology making more and more advances, bedside clinicians are facing questions that were not asked 20 or 30 years ago. The answers (some, but not all) are somewhat nebulous. For the most part, medical specialists seem unwilling or unable to answer or address these questions. Critical care physicians are uniquely placed to address end-of-life issues. The formula used by most critical care physicians is direct communication with the family in an atmosphere in which family members can interact with the medical team. The critical care physicians use many personnel to help them with this task, including ICU nurses and hospital clergy. It is important for the critical care team to address the family's goals for therapy.